Air Embolism Complicating Percutaneous Thin Needle Biopsy of Lung

Systemic arterial air embolism and tension pneumothorax: two complications of transthoracic percutaneous thin-needle biopsy in the same patient

“…A review of the literature known to us has revealed, up to now, eight cases of systemic air embolism following percutaneous biopsy; one of these resolved favourably [3]; five were fatal [12,[16][17][18]; one case developed cerebral ischaemia with permanent neurological impairment [13]; the last patient had an extensive myocardial infarction [14]. In our case another potentially fatal complication, tension pneumothorax, was identified after resuscitation.…”

“…Systemic air embolism from invasive medical procedure may be a consequence of a wide variety of causes: cardiac surgery, intravenous therapy, arterial injections, placement of central venous cannulas, head and neck procedures, mechanical ventilation, abortions, trauma and, as in this reported case, diagnostic procedures involving the lung [3,[12][13][14]. Transthoracic biopsy is an infrequent cause of air embolism reported in the literature with an incidence of 0.07 % [3].…”

“…Air may be introduced if the tip of the needle is positioned within a pulmonary vein and atmospheric pressure exceeds pulmonary venous pressure, such as during inspiration if the needle is open to the atmosphere [3,7,[12][13][14][15]. In our case this event could not have occurred as the stylet had not yet been removed at the time the symptoms developed.…”

“…Symptomatic systemic air embolism is an infrequent (incidence of 0.07 %) but severe, at times fatal, complication of lung biopsy which requires immediate recognition in order to be treated successfully [2,4,6,[12][13][14][15][16][17][18].…”

Air embolus revisited - a diagnostic and interventional radiological perspective (bubble trouble and the dynamic Mercedes Benz sign)

“…There are now numerous reports in the literature describing systemic arterial air embolisation following percutaneous procedures in the lung. [12][13][14][15][16][17][18][19][20] A further, indirect mechanism of systemic arterial air embolus is recognised. Where there is a connection between the right and left heart circulation, air emboli may bypass the filtering mechanism of the lungs and pass directly from the right heart circulation to the left heart circulation.…”